Finding Help For Hepatitis
If youve been diagnosed with viral hepatitis, there are a variety of resources that are available to help you. Lets explore a few of them below:
- Your doctor. Your doctor is a great first point of contact for questions and concerns. They can help you to better understand the type of hepatitis you have, as well as how it will be treated.
- American Liver Foundation . ALF is dedicated to ending liver disease through education, research, and advocacy. Their site has educational material about viral hepatitis, as well as ways to find doctors, support groups, and clinical trials in your area.
- Patient assistance programs. If you have hepatitis C, the cost of antiviral drugs can be high. The good news is that many drug manufacturers have patient assistance programs that can help you pay for these medications.
The chart below is an at-a-glance summary of some of the key differences between hepatitis A, B, and C.
| Hepatitis A |
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How Is It Treated
Hepatitis A is treated using supportive methods. These can include things like rest, fluids, and healthy foods. Medications can also help to ease some symptoms like fever, aches, and pains.
Theres a vaccine available to protect against infection with HAV. This is typically recommended for children as well as for people at an increased risk for contracting the virus.
Also, receiving a single dose of the hepatitis A vaccine may prevent you from becoming ill if youve been exposed to HAV. For it to be effective, the vaccine needs to be given of exposure.
What Are The Risk Factors For Liver Disease
The two most common forms of liver disease in the United States right now are both forms of fatty liver disease alcohol-related liver disease and nonalcoholic fatty liver disease, according to Dr. Lindenmeyer. As its name suggests, alcohol-related liver disease is linked with heavy alcohol ingestion, she says, while nonalcoholic fatty liver disease is linked with metabolic syndrome.
Risk factors for liver disease include the following:
- Metabolic syndrome, which is a term for a group of risk factors including high triglycerides, high levels of blood sugar, low levels of HDL , high blood pressure, and carrying extra weight around your midsection
- Excessive alcohol use
- Chronic liver infections such chronic hepatitis B or C
- Genetic or acquired medical conditions that make liver disease more likely
- Autoimmune-associated disorders of the liver
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Diabetes Obesity And Nonalcoholic Fatty Liver Disease
Several studies have shown a strong link between type II diabetes and liver cancer. Build-up of fat in the liver is common among persons with type II diabetes and may increase the risk of cirrhosis and liver cancer. This risk is higher in patients who also have other risk factors, such as heavy alcohol consumption or chronic viral hepatitis infections.
Obesity, which can contribute to fatty liver disease and cirrhosis, is a major risk factor for the development of type II diabetes, which, in turn, can increase the chance of developing liver cancer. It is unclear whether obesity directly causes liver cancer. Chronic hepatitis B and C infections are most strongly associated with liver cancer, but diabetes and obesity are major health problems that are becoming increasingly important risk factors for liver cancer.
In nonalcoholic fatty liver disease, excess fat builds up in the liver of people who drink little or no alcohol. The most severe form of nonalcoholic fatty liver disease is called nonalcoholic steatohepatitis . People with NASH have fat in their liver, along with inflammation and liver damage. They usually have no symptoms and do not know that they have a liver problem. NASH can be severe and can lead to cirrhosis. NASH is estimated to be the third most common liver disorder in North America and the most common in Australia and New Zealand.
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How Does It Affect The Body
The incubation period for hepatitis B can range from . However, not everyone who has acute hepatitis B will experience symptoms.
About 95 percent of adults completely recover from hepatitis B. However, hepatitis B can also become chronic.
The risk of chronic hepatitis B is greatest in those who were exposed to HBV as young children. Many people with chronic hepatitis B dont have symptoms until significant liver damage has occurred.
In some people whove had hepatitis B, the virus can reactivate later on. When this happens, symptoms and liver damage may occur. People with a weakened immune system and those being treated for hepatitis C are at a higher risk for HBV reactivation.
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Can Hepatitis B Be Treated What Treatments Are Available
Good treatments are available for all adults who hold Medicare cards. Treatment aims to prevent liver damage but is not an actual cure. Not everyone will need
treatment and there are short- or long term options. Please phone the Hepatitis Infoline on 1800 803 990 for more information. Read more about monitoring and treatment of hep B.
Hepatitis A: Who Is At Risk
A prime risk factor for hepatitis A is traveling to or living in a country with high infection rates. You can check the CDC’s travel advisories to learn about recent outbreaks. Eating raw foods or drinking tap water can raise your risk while traveling. Children who attend daycare centers also have a higher risk of getting hepatitis A.
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What If You Test Positive
If a test says you have viral hepatitis, you can take steps to protect the ones you love. For hepatitis A, wash hands frequently. For hepatitis B and C, avoid sharing nail clippers, razors, or toothbrushes. Hepatitis B, and sometimes hepatitis C, can be passed through sexual contact. Make sure everyone in your household gets the hepatitis B vaccine. An important step is to see a specialist to discuss treatment options.
What Makes Yale Medicine’s Approach To Treating Hepatitis B And C Unique
The Viral Hepatitis Program at Yale Medicine represents one of the leading viral hepatitis treatment programs in the country and is engaged in innovative research focused on advancing the care of patients with chronic hepatitis B, C and D infections.
A multidisciplinary team of faculty physicians and mid-level providers offer a coordinated approach to preparing patients for success. Services include structured hepatitis patient education classes, mindfulness-based stress reduction techniques , a formal physician-guided weight-loss program and access to clinical trials evaluating current and new therapies that are not available in routine clinical practice.
Our program is a core member of several national and international observational cohort studies which contributes to the advancement of science of hepatitis treatment around the world.
“Our team at Yale Medicine is uniquely equipped to serve patients with viral hepatitis from Connecticut and beyond and aims to offer outstanding, individualized, patient-centered care to help educate and guide patients through their treatment,” says Dr. Lim. We have specialists who have nationally recognized expertise in the management of viral hepatitis in special populations, including HCV-HIV coinfection, end-stage renal disease, cirrhosis/liver failure, post-liver transplant, and prior failure to respond to all-oral direct acting antivirals .
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What’s The Difference Between Hepatitis A B And C
So, what are the main differences between hepatitis A, B, and C? Let’s summarise …
- Hepatitis A and B can be passed on via bodily fluids, whereas hepatitis C usually only spreads through blood-to-blood contact with an infected person.
- Unlike hepatitis A and B, it can take years for symptoms to present themselves in hepatitis C.
- A vaccine for hepatitis B is typically offered to babies to reduce their risk of contracting the virus.
- Hepatitis C has no immunity, and it is possible to get it again, whereas the risk of becoming infected again is lower with hepatitis A and B.
What Are The Symptoms Of Hepatitis B And C
In most patients, hepatitis B develops slowly over the course of several decades, and thus most patients have no symptoms. People who have advanced liver disease such as cirrhosis of the liver may experience complications and symptoms that reflect liver failure. Other symptoms include:
- A buildup of fluid within the abdominal cavity
- Confusion and tremors , which are complications due to the inability of the liver to filter out toxins that are normally cleaned out by a healthy liver
- Vomiting of blood, or blood within the stool . This is a complication in which enlarged veins within the esophagus or stomach bleed as a consequence of increased pressure around the diseased liver.
Most patients with chronic hepatitis C infection report no symptoms. But some patients may have very nonspecific symptoms related to fatigue and discomfort on the right side of the abdomen. Often, symptoms that lead to a diagnosis of hepatitis C are noticeable only at the end stage of liver disease, when the patient has developed liver cirrhosis and liver failure.
Because hepatitis B and C typically have no specific symptoms, many people who have the viruses dont even know it.
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Is There A Cure For Hepatitis
According to Zappas, there is no technical cure for viral hepatitis, and antibodies will always test positive in a patient who has experienced hepatitis A, B or C. The management of chronic hepatitis B is complex and based on a myriad of factors. Some patients manage their condition with long-term antiviral medications.
However, vaccinations for hepatitis A and B have proven highly effective. Hepatitis A and B vaccinations are recommended and routinely done in infancy, Zappas affirmed. Most people respond to these vaccinations, but post-vaccination testing may be indicated in high-risk patients.
The outlook is even brighter when it comes to hepatitis C: Over the last 10 years, the hepatitis C treatment regimens have evolved, Zappas said. Now, theres nearly a 90% cure rate with certain antiviral medications, which can eradicate the replication of the hepatitis C RNA and therefore abate the damage of the virus on the liver. It is important to note that patients are not immune to hepatitis C after treatment, and can be reinfected and/or contract another strain.
To measure the effects, providers look for a sustained virologic response indicating that the virus remains inactive, which is evaluated between 12 and 24 weeks after beginning the medication.
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Hepatitis A: How Does It Spread
It usually spreads through food or water. Food can be tainted when it’s touched by a person with hepatitis who did not wash their hands after using the bathroom. This transfers tiny amounts of infected stool to the food. Raw shellfish, fruits, vegetables, and undercooked foods are common culprits in hepatitis A outbreaks. The virus can also spread in daycare centers if employees aren’t careful about washing hands after changing diapers.
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How Is Liver Disease Diagnosed
Screening for liver disease typically starts with blood tests that check what is called liver biochemistries, or tests of the liver function, says Lindenmeyer.
If those are abnormal, then frequently we follow that up with an imaging study of the liver, whether it be an ultrasound, a CT scan, or an MRI, she says. A specialized ultrasound device called FibroScan can give an estimate of the amount of scarring and fatty buildup in the liver.
Its important to note that sometimes people who have liver disease may have no evidence of abnormalities in their blood, says Lindenmeyer.
In some cases, a liver biopsy may be necessary to see how much scarring is in the liver.
Given that hepatitis C is often asymptomatic, screening baby boomers is critical for early diagnosis, says Lindenmeyer. We have excellent medications for hepatitis C that have excellent cure rates. Its something that can halt the progression of liver disease and potentially even improve the liver once its been treated, she says.
People who have a history of alcohol abuse or are known to drink alcohol excessively should have their liver function tested, along with those with a history of liver disease, as well as people at risk for having a genetically inherited form of liver disease, says Lindenmeyer.
What Are The Risk Factors For Hepatitis B And C
Hepatitis B: Although most commonly acquired early in life, adults can also contract it. Hepatitis B is largely transmitted through bodily fluids. It can be passed at birth from a hepatitis B-infected mother or through exposure in early childhood to body fluids, blood or contaminated medical instruments. Hepatitis B can also be transmitted through intranasal and injection drug use as well as infected tools used during tattooing and body piercing.
Hepatitis C: The key risk factors are also intranasal and injection drug use, tattoos and body piercings, high-risk sexual contact, blood transfusions before 1992 and organ transplantation.
Another key risk factor for hepatitis C is being born from 1945 to 1965, during the baby-boom years. Eighty percent of all people who currently have hepatitis C in the United States were born in that timeframe.
Although the reasons that baby boomers are more likely to have hepatitis C than others arent entirely understood, its believed that most were infected in the 1970s and 1980s, when rates of hepatitis C were at their peak.
The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend that all U.S. adults born from 1945 to 1965 undergo a one-time screening test for hepatitis C. Connecticut is one of several states that has written this recommendation into law. In Connecticut ,the law requires that primary care clinicians screen all adults born within those years.
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What Is The Outlook
Most people with hepatitis A recover without any complications. Once youve had hepatitis A, you cant get it again. Antibodies to the virus will protect you for life.
Some people may be at an increased risk for serious illness from hepatitis A. These include:
acute hepatitis B infections in the United States in 2018.
Correlation Between Histological Changes And Severity Of Liver Fibrosis
Based on the significant association of significant/severe fibrosis with the presence of NASH, we further compared the distribution of fibrosis stages based on Scheuers scoring system between patients with and without steatosis, lobular inflammation, or cytological ballooning and found that the proportion of significant fibrosis was significantly different between patient with or without lobular inflammation and patients with or without cytological ballooning . The proportion of significant fibrosis showed no difference between patients with or without steatosis . According to spearman correlation analyses, both the degree of lobular inflammation and degree of cytological ballooning were significantly associated with fibrosis stage . The presence of steatosis, presence of moderate-to-severe steatosis, and degree of steatosis were not related to the fibrosis stage .
Table 3 Spearmans correlation analysis between three histological changes and severity of fibrosis.
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Association Between Steatohepatitis And Severity Of Liver Fibrosis
The proportion of different fibrosis stages between NAFL and NASH subgroups was different . Percentage of patients with significant fibrosis or severe fibrosis was significantly higher in NASH subgroups than those in NAFL subgroups .
Factors associated with significant fibrosis or severe fibrosis are shown in Table 2. The presence of NASH, overweight, age, blood platelets count, ALT, hepatitis B surface antigen level, HBeAg status, and serum HBV DNA level were significantly associated with the presence of significant fibrosis . Among these factors, the presence of NASH, overweight, age, and blood platelets count were independent predictors for significant fibrosis under a multivariable analysis. Using the same analytic strategy, we identified the presence of NASH, diabetes, overweight, blood platelets count, albumin, and HBV DNA level as independent factors associated with severe fibrosis .
Table 2 Factors associated with significant fibrosis and severe fibrosis among patients with chronic HBV infection.
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Clinical Characteristics And Treatment Response In Different Degrees Of Hepatic Steatosis
The comparison of baseline clinical characteristics and treatment response among 102 steatotic patients with different degrees of histological steatosis is shown in Supplementary Table . As expected, patients with mild steatosis had significantly lower BMI than those with moderate steatosis and those with severe steatosis . The patients with severe steatosis had significantly lower mean HBV DNA level than those with mild steatosis , while the difference was not significant as compared to the mean HBV DNA level of those with moderate steatosis. The other clinical characteristics were comparable among these three groups. HBeAg seroclearance was achieved in 37 with mild steatosis, 14 with moderate steatosis and 5 with severe steatosis . The mean age at HBeAg seroclearance was 47.3, 42.6 and 40.8years and the median time to HBeAg seroclearance was 17.7, 15.2 and 16months , respectively in the corresponding subgroups. The VR rate was similar among three groups .
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Hepatitis A And B Vaccines
There are vaccines to protect against hepatitis A and B. The CDC recommends hepatitis A vaccination for all children ages 12 to 23 months and for adults who plan to travel or work in areas with hepatitis A outbreaks or who have other risk factors. People with chronic hepatitis B or C should also get the hepatitis A vaccine if they don’t already have immunity to the disease. The hepatitis B vaccine is recommended for all infants at birth and for adults who have any of the risk factors we discussed earlier. There is no vaccine for hepatitis C.
Nonalcoholic Fatty Liver Disease
Nonalcoholic fatty liver disease is when fat builds up in the liver of people who dont drink a lot of alcohol.
If you have excess fat in your liver and no history of heavy alcohol use, you may receive a diagnosis of NAFLD. If theres no inflammation or other complications, the condition is known as simple NAFLD.
Nonalcoholic steatohepatitis is a type of NAFLD. Its when buildup of excess fat in the liver is accompanied by inflammation. Your doctor may diagnose NASH if:
- you have excess fat in your liver
- your liver is inflamed
- you have no history of heavy alcohol use
When left untreated, NASH can cause liver fibrosis. In severe cases, this can progress to cirrhosis and liver failure.
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